(That is: research, paraphrase and correctly reference your understanding of the following terms :)
Part 2: Case Study
Susan is a 76 year old lady who was swooped by a magpie when out walking. The bird hit Susan’s left eye at speed and caused severe injury. The ambulance is called and Susan is taken to City South Hospital.
Susan is triaged in the emergency department where she was given pain relief and reviewed by the Ophthalmic surgeon. The surgeon tells Susan that although it is not urgent, she will need to have surgery on her eye.
The surgeon has a cancellation on his theatre list that afternoon. So he asks Susan to consent to having the surgery that afternoon. Hazy from the pain medication, Susan signs the consent form.
As a result of the extent of injury to the eye, Susan looses permanent sight in her left eye. Whilst recovering in the ward, Susan’s friend (a doctor) comes to visit her. EN Stuart who is looking after Susan, tells Susan’s friend that Susan is blind in one eye after surgery and gives Susan’s chart to the friend to read when he requested. EN Stuart gave the friend the chart because she believed that it was alright to do so because he was a doctor.
It is City South Hospital’s policy that bed rails are used for all post operative patients. EN Stuart did not put the rails up and Susan fell out of bed and hit her head. EN Stuart does not want to get into trouble so she does not tell anyone or document the event. EN Stuart helps Susan back to bed. Susan then develops a delirium secondary to a hematoma on her brain. Susan’s behaviour is quite erratic and the RN uses a sheet to tie her to the bed.
The afternoon shift arrives and the nurse assigned to Susan notices that she is retained to the bed via the sheet and is non-responsive. The nurse calls for assistance and medical team arrive however they are unable to revive Susan.
1. Please explain if legal, informed consent was obtained from Susan.
In the answer discuss:
a) What is Informed Consent? Include in your definition the legal age of consent.
b) Was the consent obtained from Susan Informed Consent? Explain your answer by applying one (1) example of legislation, regulation, guideline or policy that guide nursing practice in regard to informed consent.
c) Discuss the four (4) elements to the process of open disclosure in the health care environment, in your discussion, include your role as an EN and the roles of other health care workers, use examples from the case study to show your understanding of the principles of open disclosure.
2. Please explain whether EN Stuart should have given Susan’s chart to her friend to read?
In the answer:
a) Define privacy and define confidentiality.
b) Then, provide two (2) examples of legislation, regulation, guidelines or policies that guide nursing practice and apply these to EN Stuart’s actions in regard to privacy and confidentiality of documentation.
3. Please discuss whether EN Stuart was negligent and whether he breached his duty of care to Susan. In the answer discuss:
a) The tort of negligence including
1) duty of care,
2) breach of duty of care,
3) standard of care,
5) omission and
6) reasonable standard
b) Using one (1) example of legislation or regulation that guides nursing practice in regard to duty of care, and apply it to your discussion of negligence above.
4. EN Stuart did not document the use of physical restraint.
a) What are the legal requirements for documentation in your role as an EN?
b) Document a nursing progress note for the use of physical restraint on a patient
c) What is the protocol for using restraint in a healthcare facility? (list the steps).
5. Susan’s death is a coroner’s case.
a) Discuss the functions of the State Coroner
b) What is the legislation and/or regulation that guides nursing practice in regard to reportable deaths, including the nurses’s responsibilities?
6. An inquest is held into Susan’s death.
a) Define what is meant by the term “Expert Witness”.
b) Discuss what evidence might be required by the coroner’s court, and include the evidence that EN Stuart could be asked to provide.
7. Explain if EN Stuart was in breach of the Codes and Standards that govern EN practice? Using the Codes and Standards that govern EN practice, identify and discuss how EN Stuart was in breach of one (1) from each of the following documents:
a) Nursing Code of Conduct
b) Nursing Code of Ethics and
c) Enrolled Nursing Competency Standards
8. Choose an ethical dilema from Susan’s situation, and in your own words, define the steps of the Moral Decision Making Model, using your chosen ethical dilemma as an example to discuss each step of the Model.
9. A relative complained about Susan’s care while she was in hospital.
a) As an EN state how you would sensitively receive the family members complaint as per hospital policy.
b) How would you encourage the family member to advocate and support Susan’s right to care?
c) How would you respect and support Susan and her family’s decision to lodge a complaint?
10. Susan is a fit and healthy 76 year old person normally, however hypothesise that you were caring for a 76 year old person who was admitted to your ward who appeared to be malnourished with multiple cuts and bruises. Using one (1) example of legislation that guides your nursing practice, discuss the mandatory reporting responsibilities of the enrolled nurse in regards to elder abuse.
1. Ethics: It is known as the moral viewpoint and is defending, recommending and systematizing conceptions in relation to the distinction among the right things and the wrong things (Roth, 2005).
2. Bioethics: It is the revise of contentious moral question that come out from newly-fangled possibilities and situations introduced by the development in medicines and biology. It is linked with medical guiding principles, research and practices (Dickenson, 2012).
3. Nursing ethics: These are moral principles of nurses and the commitment of the nurse to the healthiness and care necessities of the patient. This ethics are meant on behalf of all the practicing nurses and at all stages of resolution construction (Ulrich, 2012).
4. Autonomy: It is the power of creation of verdicts and it is the independence of performing according to the knowledge of a definite one (Black, 2011).
5. Non-maleficence: It is to attain an advantage juncture without causing harm to any other human being (Omonzejele, 2009).
6. Beneficence: It is the activity that is performed for others advantage of other person. It is performed to eliminate the harms (Peppin, 2013).
7. Justice: It is the equality and impartiality. In nursing provided that of sufficient nursing care along with equal opportunity for everyone (Robards, 2011).
8. Rights: It is the patient right to get full care and medication by the nurse and medical practitioner (Clark, 2011).
9. Civil Law: It conquest with the clashes among the persons or with the persons and the corporations connecting to the privileges and the responsibilities to each other (Vitug, 2003).
10. Common Law: It is a structure of regulations that administers the civilization and to uphold impartiality, upholding integrity and put a stop to harm causing to persons (French, 2009).
11. Stature Law: It is a work of the legislature in written form that commands, declares or prescribes something relating to a particular set of matters. It contains a bunch of provisions relating to any particular law. Constitution of the commonwealth is the biggest example of stature law. Apart from that Australian insurance contracts act 1984 is also an example of stature law (Aph.gov.au, 2015).
12. Vicarious Liability: It refers to the when somebody is held responsible for the actions done by the other person. Like an employer can be liable for the actions of its employees (Humanrights.gov.au, 2015).
13. Open disclosure: It is the discussion of the incidents that has caused harm to patients while getting care from the nurses and the doctors (Safetyandquality.gov.au, 2015).
14. Precedent: It is a principle or rule established in a previous legal case that is either binding on or persuasive for a court or other tribunal when deciding subsequent cases with similar issues or facts (Wiseman, 2011).
15. Defendant: It means a person who has brought up before the court due to his wrongful act in civil nature (Fedcourt.gov.au, 2015).
16. Plaintiff: It means a person who has made the petition before the court of law regarding the enforcement of his or her right (Legallawyers.com.au, 2015).
17. Trespass: It means an unlawful admittance into the property of any other person (Activistrights.org.au, 2015).
18. Damages: It is the penalty paid against any civil wrong done by a person; it is famous in the name of compensation (Stewart & Stuhmcke, 2009).
19. Harassment: It is irritable torture to a person. It includes telling insulting jokes about particular racial groups, sending explicit or sexually suggestive emails, displaying offensive or pornographic posters or screen savers, making derogatory comments or taunts about someone’s race or religion, etc (Humanrights.gov.au, 2015).
20. Assault: It is the activity of accomplishing anxious and injurious contact along with a person (Aic.gov.au, 2015).
21. Battery: It is deliberately and willingly causing hurt and wrongdoing to a human being or thing connected to him or her (Judcom.nsw.gov.au, 2015).
22. False Imprisonment: It is the unlawful confinement of a person in jail without any justifies cause (Findlaw.com.au, 2015).
23. Defamation: It a fake allege made to an individual other than the person who has been defamed (Arts Law, 2015).
24. Right to Refuse: It is the right of a person to refuse any work which may cause damage or unfavourable condition (Australian Competition and Consumer Commission, 2015).
Part 2: Case study
1. a. Informed consent is the right of the patient to independence and personal fortitude. It signifies positive answer from the part of the patient to act upon him or her in relation to any treatment after disclosing all the benefits and risks of the treatment. It is inquired from a person who has attained the age of 18 years and a person with sound mind and if he or she has not attained the age of 18 years then the guardians or the parents is entitled to provide the informed consent.
Elements of Informed consent:
1. A statement relating to the conditions.
2. An explanation regarding the purpose.
3. The expected time duration of the research.
4. Disclosure about the facts relating to risk and the expected chances of success.
5. A description relating to the expected benefits.
6. Disclosure of alternative available procedures.
b. Susan did not give her consent because she was not in state of condition to provide a valid consent; she was anguish from intolerable pain. According to the law of contracts consent of a person can be taken into consideration as a valid consent if it is given in a stable mental condition and the person who is giving the consent is capable understanding the conditions. With this regard Susan was not competent to give consent.
c. Open disclosure refers to open discussion of patient’s critical condition to the concerning patient as well as patient’s family especially when health care is provided to the patient. It is very much significant from patient’s point of view. Mainly four elements are associated with this. These are as follows:
1) Concerning person who is involved in the discussion with patient, should include an expression associated with regret followed by composed explanation of actual condition (Hess, 2011).
2) Patient as well as their family gets an opportunity to relate and share their own experience.
3) Patient and their family should aware of the various adverse effects of that particular critical condition.
4) Give a structural overview for the management of that critical condition.
2. a. Privacy is an anticipation of autonomy from not permitted interruption or needless publicity.
Confidentiality denotes disclosing necessary information of the concern patient only with the relevant individuals as mentioned by the patient or lawful representative of the patient.
b. First one is ethics: EN Stuart ought not to provide her acquaintance the visual aid devoid of inspecting her name in the programmed manuscript presented to the healthiness concern which says who all be able to identify about the health of Susan. It is similar to enlightening confidentiality of Susan.
Second one is professionalism: EN Stuart has given the information diagram to her acquaintance as she believes she is a medical doctor so she knows how to examine it. According to the penal statutes this is a grave offense to disclose the privacy of the patient to any other physician apart from the personal doctor of the patient.
3. a. In relation to the performance of the duties towards Susan, there was an act of negligence from the part of EN Stuart. Here the respondent Stuart and petitioner Susan were in a relation by virtue of that Stuart was responsible for appropriate care of Susan but it has not been done by Stuart, as he was negligent in relation to performance of her responsibilities; she has not taken necessary care to pertain bed rails that were compulsory for post surgery patients that amounts to breach of duty of care. She has not fulfilled her responsibilities and she was guilty of negligence.
b. The foreseeability under this scenario is as EN Stuart had to identify the results of not giving bed rails. But then too she did that. In this case it was not an incident of omission as no optimistic surveillance is able to be observed. Under this circumstance it was obligatory to set rails as Susan has just gone through a surgery and it is a rule of reasonable standards.
4. a. There are various legal requirements for the proper documentation especially for health care system. This documentation is the vital responsibility of patient which may include the various clinical risk factors, various corporate risk factors. It also includes the some vital physiological assessment record like various blood tests (Katz, 2011).
b. from the perspective of nurse physical restrain is imposed for the benefit of the patient. As a nurse follows the direction given by the doctor and the nurse is also empowered to apply her own discretion in relation to the interest of the patient. For instance, if a patient is restricted from some kind of food then it is for the benefit of the health of that patient.
c. The following are the protocol in relation to the physical restrain of a patient:
i. As per the provisions of Mental Health Act, 200, physical restrain can be imposed upon a patient if that patient is not mentally fit and may cause harm to others.
ii. If the physical restrain is imposed in consistent with the care of the patient.
iii. Assessing of the condition of the patient in regular interval.
iv. After recovery, the restrain must be removed in the quickest possible time.
5. a. State coroner is mainly responsible for giving the proper power to investigate an incident as well as intense findings of any death, if there is suspicious incident happen. It is mainly applied for Western Australia (Miracle, 2011).
b. As per the Births, Marriage as well as death act of 2003, in under section 30 is explain the regulation that identity of the person should be demonstrated in proper way, then indicate the most probable cause of death, is it unnatural or not, is the death is result of management plan and its’ adverse effect (Parakh, 2011).
6. a) An expert witness is the one who by virtue of education, training and experiences is to have special knowledge and expertise in a specific subject above an ordinary individual so the other individuals rely legally upon his opinion and his opinion is known as expert opinion.
b) From the perspective of nurse physical restrain is imposed for the benefit of the patient. As a nurse follows the direction given by the doctor and the nurse is also empowered to apply her own discretion in relation to the interest of the patient. For instance, if a patient is restricted from some kind of food then it is for the benefit of the health of that patient (Sato, 2012).
7. a. Nursing Code of Conduct: As mentioned in conduct statement 1, nurses should have to undertake activities in a safe and competent manner (Nursingmidwiferyboard.gov.au, 2015). As a consequence, it can be said that taking care of the patient is the first concern but here Stuart by doing act of negligence didn’t follow out this conduct.
b. Nursing Code of Ethics: The value statement 4 of the nursing code of ethics states that the nurses should do their best in providing care to the patient according to the set quality standards assigned to them (Nursingmidwiferyboard.gov.au, 2015). In this particular case Susan again didn’t amend this law as she didn’t meet up the quality of care to Susan by tying her up by sheets and not providing bed rails (Gastmans, 2013).Secondly Stuart didn’t even make up the privacy and confidentiality of Susan by providing her friends the medical chart.
c. Enrolled Nursing Competency Standards: The competency element 3.3 states that nurses should have to demonstrate analytical skill in accessing as well as evaluating health information of a specific patient (Nursingmidwiferyboard.gov.au, 2015). According to this standard, the nurse’s performance is assessed to retain the licensee or to practice as a nurse in Australia. In this Stuart license can be retained as she does not meet her competency standards by providing insufficient care to Susan.
8. The ethical dilemma for Stuart in Susan’s situation may be the putting of bed rails which according empirical knowledge she should put but due to some personal belief like Susan is an old and matured lady who is having extreme pain so she would not move and stay there in the bed restrained her from putting the bed rails (Valois-NuÃ±ez,2011).
Steps for decision making model:
1. By doing this EN Stuart though all the moral values are followed.
2. This is following the ethics of providing accurate care without injuries.
3.The EN thought not putting the bed rails would not harm Susan as she is mature enough to stay in the bed patiently (Miracle, 2011).
4. The EN thought by not putting rails she is doing justice to Susan as she is a grownup who can understand things and are not adamant. She is doing justice to her freedom and her age.
5. The EN is following steps of Humanity in this. She is as a human can fell the uneasiness and lock up feeling by putting a patient in bed rails so for Susan considering her a old grown up lady she didn’t put the rails.
9. a) As an EN Stuart should first patiently listen to the complaint of her relatives than she should keep her point that she and the hospital staff is doing best to protect and safe guard Susan’s health. She can also explain the treatment steps that are being followed by the doctor and the care steps that are provided to Susan (Parakh, 2011).
b). The family should be encouraged by telling that in spite of meeting with a huge accident Susan’s life is saved, her pain is lessened but she is blind from one eye. So the nurse should convince the family by saying as Susan is already old and now without an eye they should be with her like a strong support and should bring about positive hopes in her so that she can live her life again in a proper manner (Sato, 2012).
c). As an EN the complaint lodged by Susan’s family must be respected as they do not know about the surgical procedure which was performed on her eye would be so dangerous that she became blind from one eye. So the family should be explained in detail about the happening and the reason of surgery behind this (Valois-NuÃ±ez 2011).
10. The nurses are required to deal with the old patients more seriously and amending the code of ethics and codes of nursing while dealing with them. Any harm abuse or neglect to the old people can be a danger on their nursing license. It is stated as per Aged Care Act 2007 under the section 42 by the Australian government (Zanartu, 2014).